LEGISLATIVE AND POLICY UPDATE DIRECT SERVICE TRIBES ANNUAL CONFERENCE JULY 11, 2018

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1 LEGISLATIVE AND POLICY UPDATE DIRECT SERVICE TRIBES ANNUAL CONFERENCE JULY 11, 2018 Donnie Garcia, Director, Jicarilla Apache Chairman, Albuquerque Area Indian Health Board NIHB Board Member (Albuquerque Area)

2 Behavioral Health Conference SAVE THE DATE!!

3 35 th Annual National Tribal Health Conference SAVE THE DATE!! Register at

4 Fiscal Year 2018 Omnibus Signed on March 23, Government funded through September 30, NIHB FOUGHT HARD FOR: $50 million to Tribes and Tribal Organizations for Opioids Treatment, reducing unmet need, & reducing overdose related deaths AND $5 million to Tribes and Tribal Organizations for Opioids Medication-Assisted Treatment Programs NIHB Board of Directors Passed Resolution: TRIBAL CONSULTATION ON DISBURSEMENT

5 $50 Million Opportunity Tribal Opioid Response Grants Funding Opportunity Announcement (FOA) Information FOA Number: TI Posted on Grants.gov: Thursday, June 21, 2018 Application Due Date: Monday, August 20, 2018 Catalog of Federal Domestic Assistance (CFDA) Number:

6 OMNIBUS FUNDS IHS THROUGH 2018 $5.5 billion for IHS which is an increase of just under $500 million (10%) above the FY 2017 enacted level. $3.9 billion for services $867 million for facilities $718 million for Contract Support Costs.

7 FY 2019 Appropriations Labor-HHS Subcommittee Funding Jurisdiction over US Department of Health and Human Services (Non IHS): NIHB CEO testified on April 27, 2018 ASKED: Tribal public health set asides ASKED: Increased Funds for Good Health and Wellness in Indian Country Zeroed out in President s Budget funded at $16 million in 2018/ $32 Million included for 2019! Interior-Environment Subcommittee Funding Jurisdiction over Interior and Indian Health Service NIHB Chairman Vinton Hawley testified on May 10, Advocated for full funding of IHS as recommended by the Tribal Budget Formulation Workgroup

8 Fiscal Year Interior Appropriations President's Budget Request House Interior Appropriations Tribal Budget Formulation Recommendation Senate Interior Appropriations IHS Total $5.4 billion $5.9 billion $6.4 billion $5.9 billion IHS, Hospitals and Clinics $2.1 billion $2.2 billion $2.4 billion $2.2 billion IHS, PRC $955 million $965 million $1.2 billion $964.8 million IHS, Mental Health $105.2 million $106.8 million $207.8 million $105.3 million IHS, Alcohol & Substance Abuse $235.3 million $238.6 million $327.8 million $245.6 million IHS, Dental Health $204 million $208 million $252 million $203.8 million IHS, Facilities $505.8 million $883 million $803 million $877.5 million Contract Support Costs $822 million $822 million $818 million $822 million Urban Indian Health $46.4 million $60 million $67.3 million $49.3 million Community Health Representatives 0 $63 million $92.2 million $63 million Health Education 0 $20.6 million $36 million $20.6 million SDPI, Mandatory or Discretionary? Discretionary Mandatory Mandatory Mandatory

9 Opioids Outlook Moving Forward Opioid Crisis Response Act (S. 2680) likely to be Senate s opioids package NIHB working to include priorities in amendments as the bill comes to the floor Votes likely pushed back until after Supreme Court nominee is confirmed House has passed ~60 bills related to opioids Most do not have direct Tribal impact SUPPORT for Patients and Communities Act (H.R. 6) Unclear at this point if the House will take further action without the Senate s input Congress needs to hear from you about Tribal Priorities!

10 Medicaid Workforce Requirements On January 17 th CMS issued a Dear Tribal Leader Letter stating that CMS could not provide an exemption to the Work Requirements for American Indians and Alaska Natives because of Civil Rights concerns NIHB invited NCAI and other National Native Organizations to work with Tribal leaders across the nation to evaluate whether this Administration decision was part of a greater strategy and to work together to assert a unified response and strategy to protect Tribal Sovereignty On May 7th, CMS updated its position, stating that they would actively consider state proposed accommodations for AI/AN from work requirements on a state by state basis

11 HOUSE APPROPRIATIONS COMMITTEE REPORT LANGUAGE CHAIRMAN TOM COLE (CHICKASAW) (R-OK) Tribal Sovereignty. Federally-recognized Indian Tribes are sovereign nations residing within a State. Moreover, Indian Tribes are political, sovereign entities to which the Federal government owes a trust responsibility... No discretionary action taken by any Administration can impede the direct relationship between the Federal government and the provision of health care for Indian Tribes.

12 STATE PUSHBACK: Kentucky On June 29, 2018, a Federal Judge ruled that workforce requirements as a condition of eligibility the Kentucky Waiver requiring work or community engagement was not consistent with the objectives of the Medicaid Statues and remanded the Waiver back to the Administration. This development will not resolve the matter nationally, but will likely create delay in the Administration s implementation of Medicaid work requirements.

13 Legislation Directly Impacting DSTs SENATE S Restoring Accountability in the Indian Health Service Act of 2017 Introduced by Senator John Barrasso (R-WY) 3 Cosponsors All Republican April 2018, reported out of the Senate Committee on Indian Affairs HOUSE OF REPRESENTATIVES H.R Restoring Accountability in the Indian Health Service Act of 2017 Introduced by Representative Kristi Noem (R-SD) 8 Cosponsors All Republican Referred to Four House Committees (Natural Resources, Energy and Commerce, Ways and Means, and Oversight and Government Reform) Reported out of Subcommittee: Energy and Commerce; Resources

14 Restoring Accountability in the IHS S and HR 2662 were introduced as a direct response to the health care crisis in the Great Plains LARGELY FOCUSES ON STAFFING NEEDS PURPOSE: This bill amends the Indian Health Care Improvement Act to require the Department of Health and Human Services (HHS) to establish a pay system for health care professionals employed by Indian Health Service (IHS) that is competitive with the salary of health care professionals employed by the Veterans Health Administration. HHS may establish incentives related to IHS employee recruitment and retention by providing relocation costs and rental assistanceto employees undercertain circumstances. In addition, IHS must: centralize its credentialing system for licensed health professionals seeking to provide health care services at its facilities, establishes standards to measure the timeliness of health care services in its facilities, implements an annual mandatory program that provides cultural training for certain IHS employees and contractors, and establish a demonstration project to provide additional staffing resources to understaffed IHS facilities.

15 ISSUE ON THE HORIZON Implementation of Electronic Health Records and Building Digital Infrastructure: What happens to RPMS? What do the Tribes need? What will it cost?

16 And Finally Please Join Us For WHAT: THE NIHB TRIBAL HEALTH DATA SYMPOSIUM WHEN: July 26, 2018 WHERE: Kaiser Family Foundation on Health Washington, DC

17 Thank you! For more information please contact: Stacy A. Bohlen, CEO at Devin Delrow, Director of Policy at Caitrin Shuy, Director of Congressional Relations at NIHB PHONE NUMBER: (202)